Provider Demographics
NPI:1730229048
Name:GENESEE VALLEY OBSTETRICS & GYNECOLOGY, P.C.
Entity type:Organization
Organization Name:GENESEE VALLEY OBSTETRICS & GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-697-3201
Mailing Address - Street 1:21 WILLOW POND WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2687
Mailing Address - Country:US
Mailing Address - Phone:585-641-0399
Mailing Address - Fax:585-641-0388
Practice Address - Street 1:21 WILLOW POND WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2687
Practice Address - Country:US
Practice Address - Phone:585-641-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37150AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER